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Updated: Nov 10, 2025

Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
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[Posture-dependent headache caused by spontaneous intracranial hypotension]

M E Belderbos1,2, G J Amelink3, J W Dankbaar4

  • 1Universitair Medisch Centrum Utrecht, Prinses Máxima Centrum voor Kinderoncologie, Utrecht.

Nederlands Tijdschrift Voor Geneeskunde
|April 1, 2021
PubMed

A 36-year-old woman presented with a 3-4 month history of severe, progressive headache. The headache was characterized by postural variation, with excruciating headache in the upright position and near-immediate relief upon recumbence. There was no history of trauma or lumbar puncture. Gadolineum-enhanced brain MRI revealed abnormalities characteristic intracranial hypotension. Spinal MRI showed a longitudinal extradural fluid collection; a localization of the dural defect was not found. The patient was treated with caffeine, bed rest and lumbar epidural blood patches; she recovered completely. Severe orthostatic headache which aggravates upon standing and is relieved by recumbence, can be caused by spontaneous intracranial hypotension. Recognition of its characteristic symptoms is needed for timely referral. Treatment is usually successful and can prevent life-threatening complications.

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